Provider First Line Business Practice Location Address:
911 WESTERN AVE
Provider Second Line Business Practice Location Address:
SUITE 506
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98104-3605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-632-4578
Provider Business Practice Location Address Fax Number:
206-624-4780
Provider Enumeration Date:
10/11/2006